The insula has been implicated as a component of central networks subserving evaluative and affective processes. This study examined evaluative valence and arousal ratings in response to picture stimuli in patients with lesions of the insula and two contrast groups: a control-lesion group (the primary contrast group) and an amygdala-lesion group. Patients rated the positivity and negativity of picture stimuli (from very unpleasant to very pleasant) and how emotionally arousing they found the pictures to be. Compared with patients in the control-lesion group, patients with insular lesions reported reduced arousal in response to both unpleasant and pleasant stimuli, as well as marked attenuation of valence ratings. In contrast, the arousal ratings of patients with amygdala lesions were selectively attenuated for unpleasant stimuli, and these patients' positive and negative valence ratings did not differ from those of the control-lesion group. Results support the view that the insular cortex may play a broad role in integrating affective and cognitive processes, whereas the amygdala may have a more selective role in affective arousal, especially for negative stimuli.